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1. A Systematic Review of Medication Preferences for Patients with Depression Based on Discrete Choice Experiment and Best-worst Scaling
REN Yanfeng, LIU Shimeng, TAO Ying, CHEN Yingyao
Chinese General Practice    2023, 26 (28): 3559-3564.   DOI: 10.12114/j.issn.1007-9572.2022.0824
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Background

Drug therapy is one of the main treatment approaches for depression, and a consideration of patient preferences can effectively improve patient compliance with medication. Several studies have been conducted to explore the medication choice preferences of patients with depression, but there is a lack of studies to systematically collect and summarize the medication choice preferences of patients with depression.

Objective

To systematically review the studies related to the application of discrete choice experiment (DCE) and best-worst scaling (BWS) to the medication choice preferences of patients with depression, in order to provide reference for clinical rational drug use of patients with depression and future studies of preferences.

Methods

CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science and EmBase were systematically searched for the studies related to the application of DCE and BWS to the medication choice preferences of patients with depression from inception to 2021-12-31, using "DCE" "BWS" "depression" "discrete choice experiment" "best-worst scaling" as keywords on January 2022. Data were extracted from the included literature, and the PREFS checklist was used for the quality assessment of all studies. The attributes included in the study were classified into three categories of outcome, process and cost, and their relative importance on the impact of medication preferences of patients was assessed.

Results

A total of 7 papers were included, all of which were studies related to DCE, involving 47 attributes, among which 41 were classified as outcome attributes, 5 were classified as process attributes, and 1 was classified as a cost attribute. A total of 9 most important attribute results were obtained from the 7 studies, the outcome attribute was considered most important 8 times and the cost attribute was considered most important 1 time. Among the outcome attributes, adverse effects were considered most important 5 times and effectiveness was considered most important 3 times. Based on the PREFS checklist, one study received a score of four and six studies received a score of three. Most studies need further improvement in terms of respondents and findings.

Conclusion

Outcome attributes are most important in the medicine taking process of patients with depression, which needs attention of clinicians and policy makers. There is room for improvement in the dimensions of variance reporting and experimental design, it is recommended for further improvement of research design in terms of respondents interpretation of findings and experimental design in future research, in order to provide more high-quality evidence for research of medication preferences of patients with depression.

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2. Application of Disability Point Matching Intervention Programme Based on Intervention Mapping Theory in Patients with Schizophrenia Disability
CAO Xiaolang, WANG Weiliang, YU Hong, WANG Xue, ZHOU Yuqiu
Chinese General Practice    2023, 26 (19): 2376-2384.   DOI: 10.12114/j.issn.1007-9572.2022.0849
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Background

Schizophrenia is considered as one of the top 10 leading causes of disability and life survival time threatening, which is the main cause of mental disability. There are relatively few researches on early intervention and health management for patients with mental disability in China and abroad. In particular, there is a lack of research on interventions for mental disability at different time points in China.

Objective

To explore the effect of disability point matching (DPM) intervention programme based on intervention mapping theory on degree of disability, negative symptoms, insight, self-esteem level and family function in patients with schizophrenia disability.

Methods

A quasi-experimental study design was used in the research. The patients at P1 (disability1~<2 year, 70 cases), P2 (disability 2~<3 years, 70 cases) and P3 (disability≥3 years, 70 cases) were randomly divided into the intervention group (35 cases) and control group (35 cases) by using random numbers generated by SPSS. The control group at all three time points received routine care, and the intervention group received DPM based on the routine care. The duration of the intervention was 8 weeks, once a week. The patients were assessed using WHO Disability Rating Scale (WHO-DASⅡ), Positive and Negative Syndrome Scale-Negative Subscale (PANSS-N), Self-knowledge and treatment attitude questionnaire (ITAQ), Self-Esteem Scale (SES) and family adaptation, partnership, growth, affection, resolve (APGAR) before intervention, after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention, respectively. The health outcomes between the two groups at each time point were compared by using repeated measures analysis of variance.

Results

There were main effects and interaction effects of time and group in the WHO-DASⅡ, PANSS-N, ITAQ and SES scores at P1 after DPM intervention (P>0.05), there were main effects and interaction effects of time and group in the APGAR score at P1 after DPM intervention (P>0.05). WHO-DASⅡ and PANSS-N scores were lower and ITAQ (P>0.05), SES, and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ、ITAQ、SES、APGAR scores of patients at P2 after DPM intervention. WHO-DASⅡ score was lower and SES score was higher in the intervention group than the control group at after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05), ITAQ and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ and ITAQ scores at P3 after DPM intervention. WHO-DASⅡI score was lower and ITAQ score was higher than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05) .

Conclusion

The DPM intervention program based on intervention mapping theory is effective in improving the disability degree, negative symptoms, insight, self-esteem and family function in patients with schizophrenic disability.

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3. Influence of Policy Factors on Healthcare-seeking Behaviors in Patients with Schizophrenia
LIU Rui, DENG Jing, CHEN Ailing, CHENG Peihua, LUO Xingneng, HU Yongjiao, ZHANG Munan
Chinese General Practice    2023, 26 (19): 2385-2394.   DOI: 10.12114/j.issn.1007-9572.2022.0680
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Background

In China, schizophrenia patients have a high demand for basic medical care, but irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia.

Objective

To analyze the influence of policy factors on healthcare-seeking behaviors in schizophrenia patients, to understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policies, providing empirical evidence for policy improvement.

Methods

In November 2019, we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018, with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcare-seeking behaviors and the medical institution chosen for treatment as explained variables, participation in basic medical insurance (including basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employees, and reimbursement for medical cost due to special outpatient diseases) and mental health policy coverage (involving community rehabilitation services, guardianship subsidy, subsidy from the local disability federation, subsidy from the 686 program, and free second-generation antipsychotics, and the mental disability certificate) as key explanatory variables, and patients' demographic characteristics as control variables.

Results

Of the participants, 1 915 (82.76%) had medical visits, including 1 482 seeking outpatient treatment, and 795 seeking inpatient treatment. Among those seeking outpatient treatment, the prevalence of choosing primary, secondary and tertiary care institutions was 17.01% (252/1 482), 72.87% (1 080/1 482), and 10.12% (150/1 482), respectively. And the prevalence of choosing primary, secondary and tertiary care institutions for inpatient treatment was 4.78% (38/795), 65.16% (518/795), and 30.06% (239/795), respectively. Logistic regression analysis showed that the type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviors (P<0.05). The type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the free second-generation antipsychotics program, and the level of mental disability were factors associated with choosing outpatient settings for treatment (P<0.05). The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatment (P<0.05) .

Conclusion

Policy factors played a positive role in guiding schizophrenia patients to seek medical treatment, but some problems were also revealed, such as low patient participation and insufficient coverage pathways. In view of this, efforts should be made as soon as possible to optimize mental health policies and the social support and assistance system, increase patient participation of relevant programs via strengthening the publicity of relevant policies, actively guide home-based rehabilitation activities, further promote community-based delivery of mental health services, and continuously improve the mental health security system.

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4. Characteristics of Newly Increased and Deceased Patients with Severe Mental Illness in a Community in Beijing from 2011 to 2021
SUN Xuhai, SHI Xiuxiu, ZHAO Zhengzheng, HAN Jinxiang
Chinese General Practice    2023, 26 (19): 2402-2407.   DOI: 10.12114/j.issn.1007-9572.2022.0759
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Background

There is a contradiction between a large population with severe mental illness and insufficient capacity to receive and treat them in China. Most of these patients long-termly live in the community, so it is essential for community health institutions to provide this population with timely and effective primary mental health services.

Objective

To analyze the characteristics of newly increased and decreased patients with severe mental illness in a community in Beijing from 2011 to 2021, so as to provide evidence for the implementation of community-based prevention and treatment of mental illnesses.

Methods

In January 2022, information of registered patients with severe mental illness (schizophrenia, bipolar disorder, schizoaffective disorder, persistent delusional disorder, mental disorders associated with epilepsy or mental retardation accompanied by mental disorders) in a community of Beijing was obtained through Beijing Municipal Mental Health Information Management System, including demographic characteristics, disease status and the status of file creation. The yearly morbidity, mortality and years of life lost (YLL) rates were calculated for years between 2011 and 2021. With the patient information up to December 31, 2010 as the baseline, the information of newly increased and deceased patients from 2011 to 2021 was counted.

Results

From 2011 to 2021, the newly increased patients outnumbered the deceased ones, and the prevalence rate increased year by year since 2012, reaching 3.77‰ in 2021. Compared with the baseline, patients with severe mental illness in 2021 presented the following features: higher education level, a higher proportion of employers, a higher proportion of 60-year-olds and older, a lower proportion of schizophrenics, a higher proportion of patients with bipolar disorder, and a shorter duration of non-creation of files, and the differences were statistically significant (P<0.05). During the period, there were 212 newly increased patients, and most of them suffered from schizophrenia (57.08%, 121/212) or bipolar disorder (36.32%, 77/212). The age of the first onset was mostly between 19 and 45 years (65.57%, 139/212). The number of patients with 5 years or less of duration of non-creation of files was the most (40.57%, 86/212), and the average median was 8.5 (15.5) years. Among the 90 deceased cases, schizophrenics accounted for the highest percentage (86.67%, 78/90), and those aged over 60 years accounted for 74.44% (67/90). The top three causes of death were somatic disease (84.44%, 76/90), suicide (7.78%, 7/90), and accidental death (2.22%, 2/90). The YLL rate fluctuated between -0.250‰ and 1.436‰ during the period.

Conclusion

The period of 2011 to 2021 witnessed more newly increased community residents with severe mental illness than deceased ones, an increased prevalence trend of severe mental illness, a shortened duration of non-creation of files, and the aged as the major deceased group, and somatic diseases as the major cause of death. Targeted measures should be taken to cope with the above changes.

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5. Epidemiological Survey of the Prevalence and Associated Factors of Mental Disorders in Xinjiang Uygur Autonomous Region
GE Anxin, ZHANG Guiqing, JIANG Liang, XING Wenlong, HU Min, LI Haohao, MENG Yao
Chinese General Practice    2023, 26 (19): 2395-2401.   DOI: 10.12114/j.issn.1007-9572.2022.0761
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Background

Socioeconomic development, lifestyle changes and the COVID-19 pandemic all have an impact on people's mental and physical health, which may affect the prevalence of mental disorders. Currently, there is still no sufficient epidemiological information of mental disorders in Xinjiang.

Objective

To investigate the prevalence and influencing factors of common mental disorders among people aged 15 and above in northern Xinjiang, then compare the data with those of their counterparts in southern Xinjiang, and summarize the overall prevalence of common mental disorders in Xinjiang, providing a scientific basis for the formulation of corresponding mental health plans.

Methods

From November 2021 to July 2022, a multistage, stratified, random sampling method was used to select 3 853 residents from northern Xinjiang to attend a survey. General Demographic Questionnaire, and self-assessment scales (the 12-Item General Health Questionnaire, Mood Disorder Questionnaire, Symptom Checklist-90, etc.) and other assessment scales (Hamilton Depression Inventory, Bech-Rafaelsen Mania Rating Scale, Brief Psychiatric Rating Scale, etc.) were used as survey instruments. Mental disorders were diagnosed by the ICD-10 classification of mental and behavioral disorders by two psychiatrists with at least five years' working experience, or by a chief or associate chief psychiatrist when there is an inconsistency between the diagnoses made by the two psychiatrists.

Results

The point prevalence rate and age-adjusted rate of common mental disorders in northern Xinjiang were 9.71% (374/3 853) and 10.07%, respectively. The point prevalence rate and age-adjusted rate of common mental disorders in the whole Xinjiang were 9.69% (750/7 736) and 9.90%, respectively. The point prevalence rates of mood disorders, anxiety disorders, schizophrenia, organic mental disorders, and mental retardation in northern Xinjiang were 4.83% (374/7 736), 3.63% (281/7 736), 0.63% (49/7 736), 0.23% (18/7 736), and 0.36% (28/7 736), respectively. Multivariate Logistic regression analysis for northern Xinjiang showed that: the risk of mood disorders in females was 1.854 times higher than that in males〔95%CI (1.325, 2.593) 〕; The risk of mood disorders increased by 5.210 times in 25-34-year-olds〔95%CI (1.348, 20.143) 〕 and 3.863 times in 35-44-year-olds 〔95%CI (1.030, 14.485) 〕 compared with that in those aged ≥65 years; The risk of mood disorders increased by 0.199 times in those with high school or technical secondary school education〔95%CI (0.078, 0.509) 〕 and 0.147 times in those with two- or three-year college and above education〔95%CI (0.056, 0.388) 〕 compared with that in illiteracies. The risk of anxiety disorder in females was 1.627 times higher than that in males〔95%CI (1.144, 2.315) 〕; The risk of anxiety disorder increased by 0.257 times in 15-24-year-olds〔95%CI (0.091, 0.729) 〕, 0.243 times in 45-54-year-olds〔95%CI (0.101, 0.583) 〕, and 0.210 times in 55-64-year-olds〔95%CI (0.067, 0.661) 〕 compared to that of those aged ≥65 years old. The risk of schizophrenia among people living in villages or towns was 4.762 times higher than that of those living in cities〔95%CI (1.705, 13.300) 〕; The risk of schizophrenia among people with high school or technical secondary school education was 0.079 times higher than that of illiteracies〔95%CI (0.015, 0.405) 〕.

Conclusion

The prevalence of mood disorders and anxiety disorders is high among all types of mental disorders in Xinjiang. Females, rural people, or low educated people in northern Xinjiang are more prone to various types of mental disorders.

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6. Analysis on the Correlation of Passive Suicidal Ideation with Thyroid Stimulating Hormone and Prolactin among Elderly Schizophrenia Inpatients
CAO Ziyao, QIAN Cheng, XIE Guohua, CHANG Qingsong, WU Donghui
Chinese General Practice    2023, 26 (23): 2894-2898.   DOI: 10.12114/j.issn.1007-9572.2023.0120
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Background

Passive suicidal ideation is a predictor of subsequent suicidal behavior, and the predictive value of objective biomarkers for suicidal ideation is attracting increasing attention. The incidence of passive suicidal ideation is relative high in elderly patients with schizophrenia. However, studies on passive suicidal ideation and biomarkers in this population are lacking.

Objective

To investigate the correlation of passive suicidal ideation with thyroid stimulating hormone (TSH) and prolactin (PRL) among elderly schizophrenia inpatients.

Methods

A total of 248 schizophrenia inpatients aged 60 years and above from Shenzhen Kangning Hospital were retrospective included from January 2014 to October 2018 and divided into the passive suicidal ideation group (n=37) and non-passive suicidal ideation group (n=211) according to the first item of the Suicide Subscale of the Chinese Version of Mini-International Neuropsychiatric Interview. The sociodemographic characteristics, TSH, free triiodothyronine (FT3) , free total-thyroxine (FT4) and PRL levels in the two groups were collected separately.

Results

Univariate analysis showed that the proportions of female patients, history of attempted suicide and PRL level inpassive suicidal ideation group were higher than non-passive suicidal ideation group, while the TSH level was lower than non-passive suicidal ideation group (P<0.05) . Multivariate Logistic regression analysis showed that TSH level (OR=0.654) , female (OR=10.950) , history of attempted suicide (OR=15.917) , PRL level (OR=1.018) were influencing factors of passive suicidal ideation in elderly schizophrenia inpatients (P<0.05) , PRL level (OR=1.035) was an influencing factor of passive suicidal ideation in schizophrenia inpatients aged 70 years and above (P<0.05) .

Conclusion

Elderly schizophrenia patients who are female, have a history of attempted suicide, have lower TSH level and higher PRL level were associated with a greater risk of passive suicide ideation. Elderly schizophrenia patients aged 70 years and above with higher PRL level may be more likely to have passive suicidal ideation, suggesting that more attention should be paid to these characteristics in clinical assessments of suicide risk.

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7. Influence of Parent-grandparent Coparenting Conflict on Grandparents' Depression Mediated by Grandparents' Sense of Mastery and Moderated by Their Sense of Valued Elder
MENG Huilin, GUO Fei, CHEN Zhiyan
Chinese General Practice    2023, 26 (16): 2004-2012.   DOI: 10.12114/j.issn.1007-9572.2022.0626
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Background

In China, 80% of the grandparents are taking part in caring for grandchildren. However, it has been found by available studies that involvement in taking care of grandchildren may increase the risk of depression among grandparents, which would seriously harm their quality of life, and the risk of depression is associated with parent-grandparent coparenting conflict, grandparents' sense of valued elder and sense of mastery, but the underlying mechanism still requires further investigation.

Objective

To investigate the influence of parent-grandparent coparenting conflict on grandparents' depression, and to explore the mediating and moderating mechanisms that grandparents' sense of mastery and sense of valued elder may play in it.

Methods

This study used two surveys. Grandparents (totally 626 cases) who participated in caring for grandchildren were selected by snowball sampling to attend an online survey or by convenience sampling to attend an offline survey from August to November 2021 using four questionnaires, namely the Coparenting Relationship Scale (CRS), the Pearlin Mastery scale (PMS), Grandparent Meaning Scale (GMS), and the 9-item Chinese version of the Center for Epidemiological Studies Depression Scale (CES-D-C). Pearson correlation was used to analyze the relationship of mother-grandparent coparenting conflict score, father-grandparent coparenting conflict score, PMS score, score of the valued elder dimension of the GMS and CES-D-C. PROCESS was used to examine the mediating effect of grandparents' sense of mastery and the moderating effect of their sense of valued elder between parent-grandparent coparenting conflict and grandparents' depression, and to draw a simple slope diagram.

Results

A total of 626 cases returned responsive questionnaires, with a response rate of 99.2%. The prevalence of depression tendency was 12.0% (75/626) in this study. The score of CES-D-C〔 (5.36±4.14) 〕 was found to be significantly positively correlated with mother-grandparent coparenting conflict score〔 (9.87±3.08), r=0.28, P<0.05〕, and father-grandparent coparenting conflict score〔 (7.34±3.25), r=0.35, P<0.05〕, but was negatively correlated with the PMS score 〔 (12.61±5.48), r=-0.25, P<0.05〕and the score of valued elder dimension〔 (84.13±8.58), r=-0.21, P<0.05〕. Grandparents' sense of mastery partially mediated the relationship of grandparents' depression with mother-grandparent coparenting conflict (with a size of indirect effect of 0.05, accounting for 17.2% of the total effects) and father-grandparent coparenting conflict (with a size of indirect effect of 0.04, accounting for 11.4% of the total effects). Grandparents' sense of valued elder moderated the relationship of grandparents' depression with mother-grandparent coparenting conflict (b=-0.06, P<0.05), and father-grandparent coparenting conflict (b=-0.07, P<0.05). The results of simple slope tests showed that among those with lower sense of valued elder, father-grandparent or mother-grandparent co-parenting conflict had a stronger influence on their depression than their counterparts with higher sense of valued elder.

Conclusion

Parent-grandparent (either mother-grandparent or father-grandparent) coparenting conflict is an important associated factor for grandparent's depression In this association, grandparent's sense of mastery plays a mediating role, while grandparent's sense of valued elder exerts a moderating effect. To reduce the risk of depression and promote the metal health among elders who take part in coparenting, efforts can be made to reduce coparenting conflicts and enhance the elders' sense of mastery and sense of valued elder.

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8. Effect of Childhood Trauma on Aggressive Behavior in Stable Schizophrenia Patients: the Chain Mediating Effect of Self-esteem and Resilience
SUN Yujing, ZHANG Jing, YU Hong, ZHOU Yuqiu, JIANG Wenlong, JIA Yannan
Chinese General Practice    2023, 26 (23): 2899-2906.   DOI: 10.12114/j.issn.1007-9572.2023.0030
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Background

Among people with various mental illnesses, those with schizophrenia have the highest incidence of aggressive behavior, which not only disturbs the medical environment, but also poses a great threat to family stability and social harmony. Previous regression analysis studies have shown that childhood trauma, self-esteem and resilience are influencing factors of aggressive behavior in schizophrenia patients, but few studies have explored the internal relationship between these four variables.

Objective

To explore the relationship between childhood trauma, self-esteem, resilience and aggressive behavior in schizophrenic patients using a self-constructed chain mediation model, and to clarify its internal mechanism.

Methods

A convenience sample of stable schizophrenia inpatients were selected from Daqing Third Hospital and Chifeng Anding Hospital from March 2021 to July 2022. A survey was conducted with them using a questionnaire consisting of general information questionnaire, Positive and Negative Symptom Scale (PANSS) , Childhood Trauma Questionnaire-Short Form (CTQ-SF) , Connor-Davidson Resilience Scale (CD-RISC) , Self-esteem Scale (SES) , and Aggressive Questionnaire (AQ) . Pearson correlation analysis was used to explore the correlation of AQ score with CTQ-SF, CD-RISC and SES scores. Multiple linear regression analysis was used to explore the influencing factors of aggressive behavior. AMOS 24.0 was used to construct the chain mediation model. The mediation effect of the chain mediation model was tested using Bootstrap method.

Results

Three hundred and ten cases attended the survey, and 300 of them (96.8%) who responded effectively were finally included for analysis. The average scores of PANSS, CTQ-SF, SES, CD-RISC and AQ were (18.4±3.7) , (49.7±13.5) , (26.9±6.9) , (55.2±15.5) and (84.3±19.8) , respectively. Multiple linear regression analysis showed that childhood trauma〔B=0.551, 95%CI (0.421, 0.681) , P<0.001〕, self-esteem〔B=-0.661, 95%CI (-0.908, -0.413) , P<0.001〕and resilience〔B=-0.448, 95%CI (-0.561, -0.335) , P<0.001〕 were influencing factors of aggressive behavior. Pearson correlation analysis revealed that CTQ-SF scores were positively correlated with AQ scores (r=0.695, P<0.01) and negatively correlated with SES scores and CTQ-SF scores (r=-0.524, P<0.01; r=-0.565, P<0.01) ; SES scores were negatively correlated with AQ scores (r=-0.607, P<0.01) and positively correlated with CD-RISC scores (r= 0.522, P<0.01) ; the CD-RISC score was negatively correlated with the AQ scores (r=-0.681, P<0.01) . The chain mediation model test results showed that the goodness-of-fit of the model was good. Bootstrap test showed that the 95%CI of each mediation path did not include 0, and the mediation effect was significant. The overall effect of childhood trauma on aggressive behavior was significant〔β=0.810, 95%CI (0.743, 0.871) , P<0.001〕. The indirect effect of childhood trauma on aggressive behavior, that is, acting through the mediators of self-esteem and resilience, was significant〔β=0.473, 95%CI (0.362, 0.598) , P<0.001〕. The direct effect of childhood trauma on aggressive behavior was significant〔β=0.377, 95%CI (0.179, 0.485) , P<0.001〕.

Conclusion

Self-esteem and resilience play a chain mediating role between childhood trauma and aggressive behavior in patients with schizophrenia. In the future, a risk prediction model of aggressive behavior in schizophrenia patients can be constructed to assess the risk of aggressive behavior, which is contributive to early identification and management of those at risk of aggression, thereby reducing or preventing the occurrence of aggressive behavior.

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9. Correlation between Allostatic Load Level and Depression among Women in Early Pregnancy
WANG Minghuan, LI Yuhong, YUAN Dehui, YU Min, HAN Baoliang, YU Qiaozhi, YANG Fangfang, ZHANG Qin
Chinese General Practice    2023, 26 (21): 2609-2613.   DOI: 10.12114/j.issn.1007-9572.2023.0017
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Background

Chronic stress is known to be associated with the onset of depression, allostatic load (AL) may play a significant role in the pathogenesis of depression as a comprehensive physiological index to evaluate response to the chronic stress.

Objective

To identify the association between AL level and depression among women in early pregnancy.

Methods

630 Women in early pregnancy who underwent prenatal examination in the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital from November 2021 to June 2022 were selected as the research subjects by using convenience sampling method, and were divided into the depression group (n=162) and non-depression group (n=468) according to presence or absence of depression. The general information questionnaire, Pregnancy-specific Anxiety Questionnaire and Edinburgh Postnatal Depression Scale were used for questionnaire survey, AL-related data were collected by physical examination and laboratory tests. Multivariate Logistic regression model was used to analyze the association between AL level and depression among women in early pregnancy.

Results

A total of 630 pregnant women in early pregnancy were enrolled with the depression incidence of 25.7% (162/630) , including 427 pregnant women (67.8%) with low AL level (AL<3) and 203 (32.2%) with high AL level (AL≥3) . Multivariate Logistic regression analysis showed that high AL level was the risk factor for depression among women in early pregnancy〔OR=1.651, 95%CI (1.096, 2.489) , P<0.05〕.

Conclusion

There is a positive association between AL level and depression among women in early pregnancy, high AL level will increase the risk of depression.

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10. Relationship between Different Personality Traits and Postpartum Depression: a Meta-analysis
YUAN Dehui, LI Yuhong, DONG Yuanyuan, WANG Minghuan
Chinese General Practice    2023, 26 (14): 1775-1782.   DOI: 10.12114/j.issn.1007-9572.2022.0726
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Background

Postpartum depression and personality problems have adverse effects on maternal and infant health. At present, the research results on the relationship between different personality traits and postpartum depression are still controversial, and there is a lack of the systematic reviews on it in China.

Objective

To systematically review the relationship between different personality traits and postpartum depression.

Methods

The research was performed Web of Science, PubMed, EBSCOhost, Embase, PsycInfo (Proquest) , CNKI, Wanfang Data Knowledge Service Platform, and VIP for studies on the relationship between different personality traits and postpartum depression from inception until June 4, 2021. The relevant data extraction was conducted after the quality evaluation of literature. Stata 16.0 was used for meta-analysis. Subgroup analysis and publication bias tests were performed for the relationship between neuroticism and postpartum depression. Sensitivity analysis of the relationship between different personality traits and postpartum depression was performed using rollover effect models.

Results

A total of 19 articles and 9 personality traits were finally included in the meta-analysis, including neuroticism (14 studies) , extraversion (6 studies) , agreeableness (5 studies) , openness (4 studies) , conscientiousness (4 studies) , vulnerability (3 studies) , obsessive-compulsive personality disorder (2 studies) , avoidant personality disorder (2 studies) and dependent personality disorder (2 studies) . The result of Meta-analysis showed that neuroticism 〔OR=1.30, 95%CI (1.20, 1.40) 〕, vulnerability 〔OR=1.39, 95%CI (1.10, 1.76) 〕, avoidant personality 〔OR=6.27, 95%CI (2.55, 15.40) 〕and dependent personality 〔OR=7.11, 95%CI (1.62, 31.14) 〕 were risk factors of postpartum depression (P<0.05) . Extraversion 〔OR=0.86, 95%CI (0.77, 0.97) 〕 and openness 〔OR=0.94, 95%CI (0.90, 0.98) 〕 were protective factors of postpartum depression (P<0.05) . The results of the subgroup analysis showed that the different threshold value of Edinburgh Postnatal Depression Scale (EPDS≥12 scores: OR=1.71, EPDS≥9 scores: OR=1.14, P=0.028) and different investigation time of postpartum depression (OR=1.13 for <1 week postpartum, OR=1.33 for 2-12 weeks postpartum, OR=2.22 for ≥13 weeks postpartum; P=0.008) were the sources of heterogeneity in the pooled results. Sensitivity analysis showed that the pooled results about personality traits were reliable except for obsessive-compulsive personality disorder.

Conclusion

Personality traits have different effects on postpartum depression, among which neuroticism and vulnerable personality are risk factors of postpartum depression, extraversion and openness are protective factors of postpartum depression. Postpartum depression may be more severe and more likely to occur after 13 weeks postpartum in postpartum women with neuroticism. Due to the inconsistent results of domestic and foreign researches, the relationships between avoidant, dependent, and obsessive-compulsive personality disorders and postpartum depression need to be further explored in the future.

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11. Characteristics of Somatic Symptoms and Their Correlations with Brain-derived Neurotrophic Factor and Inflammatory Cytokinesin Patients with Major Depressive Disorder
DU Yeming, ZHANG Yunqiao, WANG Zongqi, MIN Xue, CUI Yalian, WANG Yanfang
Chinese General Practice    2023, 26 (12): 1463-1471.   DOI: 10.12114/j.issn.1007-9572.2022.0652
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Background

Considerable evidence suggests that people with depressive disorder are at higher risk for somatic symptoms than normal people, but the mechanisms of susceptibility are unclear. Some studies suggest that the levels of precursor of brain-derived neurotrophic factor (ProBDNF) and inflammatory cytokines in depressive disorder patients are higher, but it is still unclear whether this is related to the accompanying somatic symptoms.

Objective

To explore the characteristics of somatic symptoms, and their correlations with BDNF and inflammatory cytokines in patients with major depressive disorder (MDD) .

Methods

A total of 59 MDD outpatients and inpatients from Mental Health Department, First Hospital of Shanxi Medical University and 32 healthy volunteers from the community were recruited from February 2019 to December 2020. Somatic symptoms were diagnosed using the Somatic Self-rating Scale (SSS, SSS score >36 and SSS score ≤36 were defined as with somatic symptoms or without, respectively) . Depression was assessed using the Hamilton Depression Rating Scale (HAMD-17) . Clinical data were collected, including gender, age, years of education, HAMD-17 score, SSS score, absorbance of ProBDNF and BDNF, and inflammatory cytokines (CRP, IL-4, IL-10, IL-18, IL-23a, HMGB1, IL-6, TNF-α, IFN-α) . Spearman's rank correlation analysis was used to investigate the correlation of somatic symptoms (including dizziness and headache, frequent and urgency of urination, cardiovascular symptoms, muscle soreness, gastrointestinal symptoms, tingling and twitching of hands and feet, choking and sighing, blurred vision, and discomfort of the throat) , SSS-S factor score and HAMD-17 score with ProBDNF and BDNF, and inflammatory cytokines.

Results

MDD patients with somatic symptoms had higher total HAMD-17 score than those without (P<0.001) . Both MDD patients with and without somatic symptoms had higher total HAMD-17 score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher total SSS score and SSS-S factor score than those without (P<0.001) . And they also had higher total SSS score and SSS-S factor score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher BDNF than those without (P<0.05) . The IFN-α in healthy volunteers was lower than of MDD patients with or without somatic symptoms (P<0.001) . ProBDNF was negatively correlated with muscle soreness (rs=-0.262, P<0.05) . CRP was negatively correlated with tingling and twitching of hands and feet (rs=-0.386, P<0.01) . IL-4 had a negative correlation with gastrointestinal symptoms (rs=-0.336, P<0.01) . IL-10 had a positivecorrelation with blurred vision (rs=0.286, P<0.05) . BDNF was positively correlated with dizziness and headache (r=0.339, P<0.01) , cardiovascular symptoms (rs=0.309, P<0.05) , gastrointestinal symptoms (rs=0.278, P<0.05) , muscle soreness (rs=0.419, P<0.01) , tingling and twitching of hands and feet (rs=0.286, P<0.05) , choking and sighing (rs=0.372, P<0.01) , discomfort of the throat (rs=0.392, P<0.01) and SSS-S factor score (rs=0.418, P<0.01) . IL-6 was positively correlated with cardiovascular symptoms (rs=0.283, P<0.05) and choking and sighing (rs=0.374, P<0.01) . TNF-α was negatively correlated with muscle soreness (rs=-0.299, P<0.05) . IFN-α showed a negative correlation with blurred vision (rs=-0.267, P<0.05) .

Conclusion

The peripheral blood IFN-α of MDD patients was lower than that of normal people. The severity of depression and BDNF level were higher in MDD patients with somatic symptoms than those without. The elevation of multiple inflammatory cytokines was correlated with the increase in the risk of somatic symptoms, suggesting that patients with MDD may be prone to somatic symptoms and adverse outcomes, requiring early intervention.

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12. Application of Cognitive Interviewing in the Development of a Help-seeking Motivation Scale for Patients with Schizophrenia
MA Rui, WANG Yu, LI Yuxin, WANG Zhengjun, ZHOU Yuqiu
Chinese General Practice    2023, 26 (23): 2907-2911.   DOI: 10.12114/j.issn.1007-9572.2022.0739
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Background

The accuracy of data collection can be affected by bias in the understanding of the items between the developer and the target population during scale development.

Objective

To adjust the items of the Schizophrenia Help-seeking Motivation Scale using the cognitive interview.

Methods

A purposive sampling method was used to select 30 schizophrenia patients from a psychiatric hospital in Daqing City from December 2021 to January 2022 to attend three rounds of cognitive interviews. The interview data were collected, and coded using the Question Appraisal System (QAS-99) , and after the coding results were collated, the scale entries were adjusted by integrating respondent feedback and expert panel comments.

Results

During the 1st round of interview, interviewees raised doubts on 11 entries, among which three were due to wording, seven were due to vague expressions, two were due to lack of inadequate knowledge, and one was due to the difficulty in recalling. And some of the entries were revised after discussion. The results of the 2nd round of interview showed that one entry was assumed to be inappropriate and was revised after discussion. The 3rd round of interview continued until the interviewees were able to understand the entries correctly, and they thought that there was no need to further revise the entries.

Conclusion

The cognitive interview effectively solved the problem of understanding differences between the developer and schizophrenia patients in the development of the Schizophrenia Help-seeking Motivation Scale, thus improving the accuracy and applicability of the scale.

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13. Plasma Cytokine Level and Influencing Factors of Depression in Stable Schizophrenia Patients
SUN Liang, LIU Zhiwei, ZHANG Yulong, ZHANG Dapeng, LI Wenzheng, YAO Xianhu, LIU Huanzhong
Chinese General Practice    2023, 26 (06): 687-691.   DOI: 10.12114/j.issn.1007-9572.2022.0440
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Background

A large body of literature suggests that plasma cytokine levels are associated with symptoms in patients with schizophrenia, but the relationship of plasma cytokines with depressive symptoms, which often occur in the late stage of schizophrenia, still needs to be explored.

Objective

To explore the relationship between plasma cytokine levels and depressive symptoms in schizophrenic patients.

Methods

Patients with stable schizophrenia were selected from Department of Psychiatry of three hospitals (Chaohu Hospital Affiliated to Anhui Medical University, Hefei Fourth People's Hospital, and Maanshan Fourth People's Hospital) from May to December 2018. The Calgary Depression Scale for Schizophrenia (CDSS) was used to evaluate the depressive symptoms, and the total score of CDSS≥5 was defined as depression. The plasma levels of interleukin (IL) -1β, IL-2, IL-6 and IL-17A were detected by flowcytometry. Spearman rank correlation analysis and multiple linear regression analysis were used to analyze the relationship between plasma cytokine and depression in stable schizophrenia.

Results

A total of 111 patients with stable schizophrenia were included, with depression prevalence of 28.83% (32/111). Spearman rank correlation analysis showed that the total score of CDSS was positively correlated with the level of plasma IL-1β, IL-2 or IL-17A (rs=0.507, 0.466, 0.374, P<0.05). Multiple linear regression analysis showed that higher level of plasma IL-17A was associated with decreased of risk of depression in stable schizophrenia (B=-0.125, P<0.05), and longer duration of schizophrenia was associated with increased of risk of depression in stable schizophrenia (B=0.343, P<0.05) .

Conclusion

Higher level of IL-17A and longer duration of schizophrenia may be correlated with depression in stable schizophrenia.

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14. Transcranial Low-level Laser Therapy: a Novel Treatment for Depression
LIANG Xuemei, WANG Rui, ZHAO Yuhuan, XU Tianjiao, WANG Wei, SUN Weidong
Chinese General Practice    2023, 26 (27): 3335-3341.   DOI: 10.12114/j.issn.1007-9572.2022.0688
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As the second most serious disease worldwide, the etiology and pathogenesis of depression have not been clearly defined. Depression treatment faces a bottleneck, due to limitations of common therapies, such as side effects associated with drug therapy and high risk of recurrence after drug therapy, high requirements for clinicians to perform psychotherapy, and high cost of modalities and disorientation in physical therapy. Transcranial low-level laser, a new therapy has recently proven to be effective in scientific research and clinical antidepressant treatment, utilizes low-level laser non-invasively passing through the skull without causing damage to regulate biological tissues and protect neurons. Even though the molecular and cellular mechanisms underlying the therapy for depression are not yet clear, this non-drug therapy could be highly promising for depression treatment.

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15. Eye Movement Desensitization and Reprocessing versus Sertraline in the Treatment of Depressed Adolescents with Childhood Trauma
HU Shuwei, OU Wei, WANG Zhi, PENG Juan
Chinese General Practice    2023, 26 (06): 692-698.   DOI: 10.12114/j.issn.1007-9572.2022.0650
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Background

Depressed adolescents with childhood trauma often present with more severe symptoms and are insensitive to drugs. Eye movement desensitization and reprocessing (EMDR) plays a unique role in the treatment of trauma-related mental disorders. It has been gradually used in the treatment of depression and has achieved certain results recently, but there are few related studies in China.

Objective

To assess whether EMDR has better efficacy than sertraline in the treatment of depressed adolescents with childhood trauma using a comparative analysis, providing scientific evidence for further promoting clinical application of EMDR.

Methods

Sixty depressed adolescents with childhood trauma were recruited from Psychological Clinic, Affiliated Hospital of Zunyi Medical University from December 2020 to February 2022, and equally randomized into a sertraline group and an EMDR group. Sertraline group received a eight-week treatment with sertraline: the dose was 50 mg/d in the first week and gradually increased to 100 mg/d in the second week, and could be increased to 200 mg/d at the end of the fourth week if the patients had negative ideas or self-injurious behavior. The EMDR group received EMDR treatment, once a week, for a total of 8 weeks. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate the psychological status of the two groups before treatment, four weeks and eight weeks after treatment.

Results

Except for five dropouts, the remaining cases who completed the trial were finally included, including 28 in the sertraline group and 27 in the EMDR group. The treatment type and treatment duration had interactive effects on the BDI, BAI and CD-RISC scores of the two groups (P<0.05). The treatment duration had significant main effects on the BDI, BAI and CD-RISC scores of the two groups (P<0.05). The treatment type had significant main effects on BAI and CD-RISC scores of the two groups (P<0.05), but produced no significant effects on the BDI scores (P>0.05). EMDR group had higher average CD-RISC score than sertraline group at four weeks after treatment (P<0.05). EMDR group had higher average CD-RISC score, and lower average BDI and BAI scores than sertraline group at eight weeks after treatment (P<0.05). In the sertraline group, the average BDI score at eight weeks after treatment was much lower than that at baseline or four weeks after treatment (P<0.05), the BDI score after 4 weeks of sertraline treatment was lower than that before treatment (P<0.05), and the average BAI score at eight weeks after treatment was much lower than that at basetime (P<0.05). In the EMDR group, the average BDI and BAI scores decreased significantly while the average CD-RISC score increased significantly at both four and eight weeks after treatment compared with baseline levels (P<0.05). And compared with four-week treatment, eight-week treatment lowered the average BDI and BAI scores more significantly, and increased the average CD-RISC score more significantly (P<0.05) .

Conclusion

Sertraline could partially improve depression and anxiety in depressed adolescents with childhood trauma, but had no significant improvement of psychological elasticity. In contrast, EMDR could effectively improve the depression and anxiety as well as psychological elasticity, so it could be used as the preferred treatment.

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16. General Practitioner Implements Family Therapy for a Depressed Patient
JIANG Yue, LI Jie
Chinese General Practice    2023, 26 (13): 1667-1670.   DOI: 10.12114/j.issn.1007-9572.2022.0450
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Family systems theory is a characteristic theory in general practice, which suggests that in the process of diagnosis and management of a patient, besides physiological problems, general practitioners should pay attention to the influence of family factors on the disease development and treatment as well as rehabilitation of the patient. We reported a case of depression treated with family therapy by the general practitioner after analyzing the impact of her family factors using biopsychosocial model and ideas of general medicine, hoping to improve general practitioners' capability of family-based disease management.

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17. Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach
YI Huijie, LI Jianxiang, ZHANG Chi, XU Liyue, DONG Xiaosong, HAN Fang
Chinese General Practice    2022, 25 (33): 4179-4184.   DOI: 10.12114/j.issn.1007-9572.2022.0265
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Background

The treatment adherence is closely related to the effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) , which is also strongly influenced by patients' psychosocial characteristics. However, the influence of depression symptoms on the adherence to CPAP needs to be further explored.

Objective

To evaluate the relationship of depression symptoms with adherence to CPAP, and the pathwaybetween the associated factors in OSA patients.

Methods

A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center, Peking University People's Hospital from May 2019 to July 2021 were selected. The general information, disease severity and adherence to CPAP were evaluated. The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) . The severity of insomnia was assessed by the Insomnia Severity Index (ISI) . The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) . The 12-item Short Form Health Survey (SF-12) was used to evaluate the quality of life. The relationships among variables were determined by path analysis.

Results

The prevalence of depressive symptoms in OSA patients was relatively high (19.7%, 35/177) in our study. Depression symptoms were associated with increased insomnia prevalence (r=0.65, P<0.05) , and decreased levels of activities of daily living (r=-0.51, P<0.05) and quality of life (rPCS=-0.27, P<0.05; rMCS=-0.72, P<0.05) . In addition, depressive symptoms had no relationship on the adherence to CPAP (r=0.09, P>0.05) , but could increase the adherence to CPAP by decreasing the activities of daily living (β=0.078, P<0.01) .

Conclusion

Depressive symptoms were significantly associated with insomnia, decreased quality of life and activities of daily living in OSA patients, and could increase patients' adherence to CPAP through decreasing the activities of daily living.

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18. Comparative Study of Cognitive Function in Inpatients with Generalized Anxiety Disorder and Healthy Controls
TANG Chong, ZENG Shufei, LIANG Hanwen, WANG Jiajia, ZOU Hui, CAI Lidan, ZHANG Bin
Chinese General Practice    2022, 25 (35): 4399-4405.   DOI: 10.12114/j.issn.1007-9572.2022.0481
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Background

Generalized anxiety disorder is a common chronic psychiatric disorder, which leads to cognitive impairment and seriously affects the quality of life and social function of patients.

Objective

To compare the differences in cognitive function between GAD inpatients and healthy controls.

Methods

From August 2018 to January 2020, GAD patients hospitalized in Nanfang Hospital, Southern Medical University were selected as the GAD group (n=30) . At the same time, age- and gender-matched healthy volunteers were recruited from the escorts of inpatients in Nanfang Hospital, Southern Medical University as the healthy control group (n=30) . The Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) and Beck scale for suicide ideation-Chinese Version (BSI-CV) were used for psychological evaluation. Psychomotor vigilance task (PVT) , Go/No-go association task and N-back task were used to evaluate the cognitive function of attention, inhibition and working memory separately. The differences in general conditions, psychological characteristics, and cognitive function between two groups were compared. Multivariate Logistic regression analysis was further used to compare the differences in cognitive function between GAD inpatients and healthy controls.

Results

The total scores of HAMA and HAMD, the total scores of BSI-CV at the most severe condition and the proportion of the patients with suicidal ideation at the most severe condition in GAD group were higher than those in control group (P<0.05) . N-back task: the percentage of hitting targets at 1-back (NBACK1a) and 2-back (NBACK2a) in GAD group were both significantly lower than that in control group (P<0.05) ; the average reaction time of hitting targets at 1-back (NBACK1b) in GAD group was significantly longer than that in control group (P<0.05) . Multivariate Logistic regression analysis showed that NBACK1a〔OR=0.946, 95%CI (0.898, 0.997) , P=0.038〕and NBACK1b〔OR=1.007, 95%CI (1.000, 1.014) , P=0.042〕 were the influencing factors of GAD.

Conclusion

GAD inpatients perform worse than healthy controls mainly in working memory, which deserves more clinical attention.

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19. A Comparative Study of Event-related Potential N400 between Anxious and Melancholic Depression
DU Yeming, ZHANG Yunqiao, HAN Min, WANG Yanfang
Chinese General Practice    2022, 25 (36): 4546-4553.   DOI: 10.12114/j.issn.1007-9572.2022.0351
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Background

There are many subtypes of major depressive disorder (MDD) . Evidence about the differentiation of them is mostly based on symptomatological characteristics, but rarely by objective biological indicators.

Objective

To explore the differences in event-related potential (ERP) N400 between patients with different subtypes of depression, providing an objective electrophysiological basis for subtyping depression.

Methods

Two hundred and nine outpatients and inpatients who met the diagnostic criteria of MDD in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were selected from First Hospital of Shanxi Medical University from February 2019 to December 2021, including 78 with anxious depression (ASD+MD-) , 46 with melancholic depression (ASD-MD+) , 61 with anxious and melancholic depression (ASD+MD+) , and 24 with non-anxious and melancholic depression (ASD-MD-) subtyped using the 30-item Inventory of Depressive Symptomatology (IDS-30) and 17-item Hamilton Depression Rating Scale (HAMD-17) . Thirty-five community-living health volunteers were recruited as controls at the same time.The factor and total scores of the HAMD-17 and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) of all subjects were collected. And the latency and amplitude of N400 component of all subjects were collected by inducing N400 components through understanding ambiguous words at the end of sentences.

Results

(1) The total score and factor scores of HAMD-17 differed significantly across MDD subgroups and control group (P< 0.05) . The total score of HAMD-17 in each of the four MDD subgroups was much higher than that in control group (P<0.05) . ASD+MD+ subgroup had significantly higher total score of HAMD-17 than both ASD-MD- and ASD-MD+ subgroups (P<0.05) .ASD+MD- subgroup had significantly higher total score of HAMD-17 than ASD-MD+ subgroup (P<0.05) . The score of anxiety factor in each of the four MDD subgroups was obviously higher than that in control group (P<0.05) . ASD+MD- subgroup had obviously higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P<0.05) .ASD+MD+ subgroup had prominently higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P < 0.05) . The score of body weight factor in ASD+MD+ or ASD+MD- subgroup was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of body weight factor than both ASD-MD- and ASD-MD+ subgroups (P<0.05) . The score of cognitive impairment factor in each of the four MDD subgroups was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of cognitive impairment factor than ASD-MD+ subgroup (P<0.05) . The scores of block factor and sleep disturbance factor in each of the four MDD subgroups were significantly higher than those in the control group (P<0.05) . (2) The total score and factor scores of RBANS varied significantly across four MDD subgroups and control group (P<0.05) .The total score of RBANS and scores of its factors of immediate memory, visual span, speech function, attention, and delayed memory in each of the four MDD subgroups were much lower than those in the control group (P<0.05) . The score of immediate memory factor in ASD+MD+ group was notably lower than that in ASD-MD+ group (P<0.05) . (3) There were no significant differences in latency and amplitude of N400 component across four MDD subgroups and controls (P>0.05) .There were no significant differences in latency and amplitude of N400 component across different electrode sites (P>0.05) , and there were no interaction between no-depression or each of the four subtypes of MDD and electrode sites (P>0.05) . (4) The N400 amplitude value at Fz electrode was negatively correlated with the cognitive impairment factor score (r=-0.170, P=0.016) .The N400 amplitude value at Cz electrode was positively correlated with the block factor score (r=0.151, P=0.033) .The N400 amplitude valueat Pz electrode was positively correlated with the block factor score (r=0.174, P=0.014) .The N400 amplitude value of the Fz electrode was positively correlated with the immediate memory score (r=0.138, P=0.050) .The N400 latency value at Cz electrode was negatively correlated with the delayed memory score (r=-0.155, P=0.028) .

Conclusion

Extensive cognitive impairment was found in MDD patients, including impaired immediate memory, speech function, attention and delayed memory. ASD+MD+ and ASD+ MD-patients had more severe symptoms, and ASD+MD+ patients had the most severe cognitive impairment. N400 amplitude value was negatively correlated with cognitive impairment and positively correlated with block factor in MDD patients. But these patients demonstrated no impaired function of speech integration induced by ambiguous words at the end of sentences.

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20. Hot Spots and Cutting Edge Trends in CiteSpace based Research on Social Anxiety among College Students
LI Keke, YU Wenbing, LI Shuoqi, JIAO Qianxin, JU Mingxiao, GAO Lili, WANG Caixia
Chinese General Practice    2022, 25 (33): 4217-4226.   DOI: 10.12114/j.issn.1007-9572.2022.0390
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Background

Mental health problems among college students have become increasingly prominent. Social anxiety is one of the prevalent psychological problems among college students.

Objective

To explore the research hot spots, frontiers and trends on social anxiety among college students, and provide reference for researchers participating in the research of college students' social anxiety in the future.

Methods

643 English articles in database of Web of Science (WOS) and 166 Chinese articles in database of China National Knowledge Infrastructure (CNKI) from 2000 to 2021 were analyzed using CiteSpace on August 27, 2021.

Results

The number of English articles on social anxiety among college students showed an increasing trend from 2000 to 2021. The research hot spots and frontiers of social anxiety among college students were mainly focused on substance abuse, mobile phone and internet addiction, negative evaluation fear, racial differences, psychological intervention and COVID-19 epidemic. The future research trends were mainly focused on the mechanism of substance abuse and mobile phone addiction.

Conclusion

Chinese scholars can refer to the research hot spots, trends and the differences between domestic and foreign research shown by this visual analysis, and focus on the related problems of substance abuse and mobile internet addiction among college students with social anxiety.

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21. Advances in the Use of Regional Homogeneity from Resting-state Functional MRI for the Diagnosis of Insomnia in Depressive Disorder
CHEN Pinqi, ZHANG Liqing, XIANG Ting, SUN Xizhe, PAN Jiyang
Chinese General Practice    2022, 25 (35): 4462-4467.   DOI: 10.12114/j.issn.1007-9572.2022.0443
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Insomnia is a common concomitant symptom in patients with depressive disorder. Early and effective assessment of insomnia symptoms in these patients is the key to preventing sleep problems and delaying the deterioration of depression disorder. Currently, the effectiveness of subjective and objective sleep assessment tools has often been expounded in relevant reviews, but the assessment indicators related to insomnia in depressive disorder, and rs-fMRI technique, an objective sleep assessment tool, have been rarely reviewed. We reviewed the latest advances in the use of regional homogeneity from resting-state functional MRI for the diagnosis of insomnia in major depressive disorder, and described its use in the differentiation between unipolar and bipolar disorders, with a view to providing theoretical and practical evidence for clinical diagnosis, differentiation, and treatment of unipolar and bipolar disorders, and for relevant studies.

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22. Co-prevalence of Substance Use Disorders and Common AxisⅠDisorders in Yunnan's Drug Users
ZHANG Guanbai, ZHENG Ling, YANG Liping, ZHOU Qin, WANG Fei, HE Liangze, CHENG Xuan, CHA Li, LI Xinyue
Chinese General Practice    2022, 25 (36): 4554-4560.   DOI: 10.12114/j.issn.1007-9572.2022.0426
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Background

Mental disorders in drug users have received increasing attention. However, there are no any epidemiologic data available in regard to substance use disorders (SUD) and other mental disorders in drug users in Yunnan, one region that is hit hardest by epidemic of drug use in China.

Objective

To investigate the co-prevalence of SUD and a common mental disorder, axisⅠdisorders, among Yunnan's drug users.

Methods

A cross-sectional survey was conducted among a convenient sample of 598 male drug users who received detoxification treatment from the 5th Compulsory Detention and Forced Detoxification Center of Yunnan Province and Dali Compulsory Detention and Forced Detoxification Center between August and November, 2020. According to the diagnosis of SUD, the participants were divided into three groups: opioid use disorder group (n=245) , methamphetamine use disorder group (n=197) and double use disorder group (n=146) . The Chinese version of SCID-Ⅰ/P was used to assess the prevalence of common axisⅠmental disorders (psychosis disorder, affective disorder, alcohol use disorder, and sedative-hypnotic use disorder) . The lifetime prevalence of these disorders among the three groups was compared.

Results

Among the 598 cases, there were 588 cases diagnosed with SUD (opioid, methamphetamine, or both) . The lifetime prevalence of psychosis disorder, alcohol use disorder, sedative and hypnotic use disorder among the three groups was significantly different (P < 0.05) . The overall lifetime prevalence of schizophrenia, other primary and drug induced psychotic disorders was 15.82%. The lifetime prevalence of psychotic disorder in opioid use disorder group (5.31%) was lower than that of methamphetamine use disorder group (20.30%) or that of double use disorder group (27.40%) (P<0.05) . The overall lifetime prevalence of affective disorders was 21.77%. To be specific, the lifetime prevalence of affective disorders was 17.14% in opioid use disorder group, 25.38% in methamphetamine use disorder group, and 24.66% in double use disorder group. The overall lifetime prevalence of alcohol use disorder was 42.18%. Specifically, opioid use disorder group had lower lifetime prevalence of alcohol use disorder than methamphetamine use disorder group (35.10% vs 45.69%) and than double use disorder group (35.10% vs 49.32%) (P<0.05) . The overall lifetime prevalence of sedative or hypnotic use disorder was 13.61%. The lifetime prevalence of sedative or hypnotic use disorder was 19.18%, 22.60% and 0 in opioid use disorder group, double use disorder group, and methamphetamine use disorder group, respectively.

Conclusion

The prevalence of the above-mentioned mental disorders in drug users in Yunnan Province was much higher than that in the general population. Moreover, these mental disorders may be even more prevalent in methamphetamine use disorder population than in opioid use disorder population.

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23. Expert Consensus on Long-acting Injectable Antipsychotic in the Treatment of Schizophrenia in Community
Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry, Chinese Society of General Practice
Chinese General Practice    2022, 25 (29): 3587-3602.   DOI: 10.12114/j.issn.1007-9572.2022.0537
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Schizophrenia is a chronic, recurrent and disabling psychotic disorder. Enhancing patient adherence and preventing recurrence are the key factors of treating schizophrenia, and the core determinants of prognosis and social functional recovery of these patients. Recommended by guidelines/consensuses as one treatment for schizophrenia, long-acting injectable (LAI) antipsychotics have been an important intervention for treating schizophrenia and for preventing its recurrence. At the same time, as community settings are important sites for the rehabilitation of schizophrenia, considerable efforts have been made to explore models of community-based management of schizophrenia. Currently, the use of LAI antipsychotics in community-based management of schizophrenia has been highlighted in multiple policies and documents of China, but its application is negatively influenced partially by community physicians' insufficient understanding and application skills regarding LAI antipsychotics, which has become a bottleneck that hinders the comprehensive rehabilitation of schizophrenics. In view of this, a consensus was developed based on clinical evidence, previous guidelines and consensuses, expert individual practice and features of community settings in China, by a group of 13 experts, including psychiatrists from the Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry, and general medicine experts from the Chinese Society of General Practice. This consensus will significantly contribute to the solving of problems in the use of LAI antipsychotics for community-based management of schizophrenia, and the improvement of patient adherence and prognosis.

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24. Death Status and Trends of Female Mental Disorders Patients in Pudong New Area of Shanghai, 2005-2021
SHEN Dingyi, LI Xiaopan, MENG Fanping, LU Jingjue, ZHOU Yixin, LYU Jun
Chinese General Practice    2022, 25 (32): 4072-4078.   DOI: 10.12114/j.issn.1007-9572.2022.0290-1
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Background

There are few epidemiological analyses on mental illness deaths among Chinese residents. As an economically developed region, Shanghai has more complete health information system, which can provide data support for deeper analysis of smaller categorical disease characteristics and causes of death among residents, and analysis of the circumstances and trends of deaths related to mental disorders among women in Shanghai will help to understand the local burden of mental disorders in women.

Objective

To analyze the death status and trend of mental disorders among female residents in Pudong New Area of Shanghai from 2005 to 2021.

Methods

Cause of death monitoring data of registered residents of the whole population in Pudong New Area from 2005 to 2021 were collated, and deaths of local female residents with mental disorders were analyzed by using indicators such as crude mortality rate, standardized mortality rate, years of life loss and rate of life loss, and annual percentage change (APC) and average annual percentage change (AAPC) were calculated by using Joinpont regression model for trend analysis.

Results

From 2005 to 2021, there were 1 165 female deaths from mental disorders in Pudong New Area of Shanghai, accounting for 0.32% of the total deaths in the same period. The crude mortality rate was 4.82/100 000, and the standardized mortality rate was 1.85/100 000. The crude mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend from 2005 to 2012 (APC=-13.05%, P=0.002), and an upward trend from 2012 to 2021 (APC=7.66%, P=0.012). The standardized mortality rate showed a downward trend from 2005 to 2012 (APC=-16.79%, P<0.001), and a overall downward trend from 2005 to 2021 (AAPC=-4.93%, P=0.009). The life loss rate showed a downward trend from 2005 to 2012 (APC=-13.79%, P<0.001), and an upward trend from 2012 to 2021 (APC=6.93%, P=0.011). From 2005 to 2021, the death age of female mental disorders in Pudong New Area of Shanghai was 50.8-105.8 years old, and the death age distribution was dominated by ≥80 years old (79.48%), and the death rate of female mental disorders ≥80 years old showed an overall upward trend (AAPC=0.98%, P=0.027). From 2005 to 2021, the proportion of women who died at aged 70-79 with mental disorders was 16.57%. The death rate (AAPC=-5.13%, P=0.026), crude mortality rate (AAPC=-7.20%, P=0.003) and life loss rate (AAPC=-6.89%, P=0.005) showed a downward trend as a whole.

Conclusion

From 2005 to 2021, the standardized mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend as a whole, but the death rate of female mental disorders≥80 years old showed an overall upward trend. The burden of mental disorders among elderly female residents deserves attention of local authorities. Promoting the mental health of elderly women is conducive to improving the health level of local women.

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25. Influence of HIV-related Knowledge and Anticipated Stigma on Depression of Men Who Have Sex with Men: a Latent Class Analysis
Zhenwei DAI, Mingyu SI, Yijin WU, Xu CHEN, Jiaqi FU, Yiman HUANG, Hao WANG, Weijun XIAO, Fei YU, Guodong MI, Xiaoyou SU
Chinese General Practice    2022, 25 (30): 3803-3809.   DOI: 10.12114/j.issn.1007-9572.2022.0360
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Background

Chinese men who have sex with men (MSM) have a higher prevalence of depression than the general population. Long-term depression symptoms could increase the risk of having physical harm, self-harm and suicide. Therefore, depression issues among MSM need to be solved urgently.

Objective

To explore the latent classes of depression, and the influence of HIV-related knowledge and anticipated stigma on depression among MSM.

Methods

Usingthe General Information Questionnaire, HIV Knowledge Questionnaire, Anticipated HIV Stigma Scale and 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) , an online questionnaire survey was conducted from December 2020 to March 2021 via the same-sex social network of Blued7.5. A total of 1396 MSM with HIVinfection or unclear status of HIVinfection were sampled by use of convenience sampling to attend the survey. The latent classes of depressive symptoms were analyzed by latent class analysis. Multinomial Logistic regression analysis was used to explore the correlation of the latent class of depression with HIV-related knowledge or anticipated HIV stigma.

Results

Finally, 1 394 cases (99.9%.) who returned responsive questionnaires were included. The 10 items of CES-D-10 were taken as observed indicators, and exploratory latent class analysis was employed to identify the latent classes of depression based on model from 1 to 5 classes. The 4-class model was finally selected, and the probabilities of each class were 40.1% (no obvious depression) , 21.6% (possible risk of depression) , 28.0% (possible mild depression) , and 10.3% (possible moderate to severe depression) . The accuracy of the classification was assessed by test for homogeneity according to the cut-off value of CES-D-10 (0=no depression, 1=depression) and the results of latent class analysis (0= no obvious depression and possible risk of depression, 1= possible mild depression and possible moderate to severe depression) , and the result showed that Kappa=0.735 (P<0.001) . Multinomial Logistic regression analysis indicated that a high level of HIV-related knowledge (OR=0.926, P=0.001) , undergraduate attainment or above (OR=0.642, P=0.003) were related to possible risk of depression. The anticipated HIV stigma (OR=1.594, P<0.001) and being married (OR=0.593, P=0.026) were related to possible mild depression. A high level of HIV-related knowledge (OR=0.935, P=0.026) , anticipated HIV stigma (OR=2.239, P<0.001) and no long-term employment (OR=1.518, P=0.045) were related to possible moderate to severe depression.

Conclusion

The depression in MSM population presented obvious category characteristics, which may be a new idea for tailoring interventions to depression in MSM. Relevant authorities may cooperate with social media to deliver interventions incorporated with HIV-related knowledge and anticipated HIV stigma to prevent and control the development of depression in MSM.

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26. Anxiety Prevalence and Influencing Factors in Young and Middle-aged Office Building Occupants
Wenlei PAN, Yongqing XU, Xiao LYU, Jian XU, Gang YAO, Jie SHAO, Rui LIU, Xin LI, Jianwei SHI, Jiaoling HUAGN
Chinese General Practice    2022, 25 (22): 2790-2795.   DOI: 10.12114/j.issn.1007-9572.2022.0011
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Background

The prevalence of sub-health problems is increasing in young and middle-aged office building occupants, in which the percentage of mental health problems is on the rise. Shanghai took the lead in delivering family doctor services via the health station set in an office building in June 2018, but mental health in young and middle-aged people has not yet been insufficiently covered by the services.

Objective

To assess the prevalence of anxiety and influencing factors in young and middle-aged office building occupants in Shanghai.

Methods

A questionnaire survey for estimating anxiety prevalence was carried out in typically sampled office buildings from Hongkou District, Pudong New District and Jing'an District of Shanghai during December 2019 to December 2020. Cluster random sampling was used to sample young and middle-aged occupants (18-59 years old) in the buildings, and 2 198 cases of them who completed the survey were included as the participants for analysis. Anxiety was diagnosed by the score of the Zung's Self-Rating Anxiety Scale. Multiple linear regression was used to estimate the association of anxiety prevalence with socio-demographic and economic characteristics, and health status as well as lifestyle.

Results

Among the participants, the prevalence of no anxiety, mild, moderate and severe anxiety was 60.42% (1 328/2 198), 18.61% (409/2 198), 12.46% (274/2 198), and 8.51% (187/2 198), respectively. Multiple linear regression analysis found that registered place of household (Shanghai or not), education level, self-rated social class, self-rated health, frequency of physical examination, level of fatigue, chronic disease prevalence and regular medication were associated with anxiety prevalence (P<0.05) .

Conclusion

The prevalence of anxiety was high in this group of population, which may be associated with the population characteristics. In view of this, mental health should be valued during the delivery of family doctor services for these people, and targeted interventions can be provided according to personal anxiety status when necessary.

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27. Research Progress on the Effect of Exercise and Neurobiological Mechanism on Depression
Shaokun WANG, Shiqiang WANG, Yijie WANG, Zhihan XU
Chinese General Practice    2022, 25 (27): 3443-3451.   DOI: 10.12114/j.issn.1007-9572.2022.0273
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Exercise has been confirmed by most studies to be effective in preventing and treating depression, and has become a recommended treatment by many researchers. However, previous research results on exercise interventions for depression have not been effectively integrated, and there is still a lack of uniform clinical exercise therapy guidelines across countries. In this paper, we systematically and comprehensively discussed the effects of exercise on depression, including the effects of exercise types, intensities, frequencies, and amounts of exercise on the efficacy of depression interventions in different populations, and summarized the neurobiological mechanisms involved in the development of depression as well as the antidepressant effects of exercise by sorting out relevant literature. This paper shows that in exercise interventions for depression, aerobic exercise is the most frequently chosen type of exercise, the intensity of which is usually moderate to high intensity, and the frequency and amount of exercise are recommended at high frequency and dosage. The neurobiological mechanisms of exercise resistance to depression are mainly that exercise can improve the morphological structure of central nervous system tissue, increase the levels of a series of neurotrophic factors, thereby enhancing neuronal plasticity, and improve the function of the neurosecretory system, reducing damage to brain tissue caused by neuroinflammatory responses and oxidative stress. This paper can provide a certain reference for the development and implementation of clinical exercise prescription for depression in China, and draw on the in-depth development of exercise antidepressant research.

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28. Progress in Clinical Treatment of Heart Failure with Preserved Ejection Fraction Combined with Depression
LIU Xianling, HONG Jian, WANG Kai, QIAN Lijun, SUN Yan, MA Wenjie, LI Zhongming, XU Di
Chinese General Practice    2022, 25 (33): 4196-4202.   DOI: 10.12114/j.issn.1007-9572.2022.0315
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Heart failure with preserved ejection fraction (HFpEF) is a common type of heart failure (HF) , and previous treatments that primarily target heart failure with reduced ejection fraction (HFrEF) do not benefit the patients with HFpEF because of the differences in their pathophysiological mechanisms, resulting in high mortality and poor prognosis. Whereas depression is one of the most common mental and psychological problems, caused by various reasons and characterized by a pronounced and long-lasting low spirits, with various degrees of cognitive and behavioral changes. Those who are severely ill even present self-injurious and suicidal behavior. With intensive research into HFpEF, it has emerged that depression has become one of the most common comorbidities in HFpEF and that the two interact to contribute to poor prognosis for patients. Currently, relevant studies in HFpEF with depression suggested that some drugs could improve short term symptoms and clinical prognosis in such patients. This paper aimed to review the comorbid mechanism, research status and the latest progress of related treatment of HFpEF complicated with depression. It is found that sodium glucose cotransporter 2 (SGLT2) inhibitors, angiotensin receptor enkephalinase inhibitors (ARNI) and statin drugs play important roles in the field of HF and psychophysiology. They can not only improve the cardiac function and prognosis of HFpEF patients, but also have the effect of anti-depression, thus to provide references for clinical study and treatment.

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29. Classification and Comparative Analysis of Prediction Models for Postpartum Depression
Yongjian WANG, Weijing QI, Yipeng WANG, Sha HUANG, Cong LI, Na WEI, Jie HU
Chinese General Practice    2022, 25 (24): 3036-3042.   DOI: 10.12114/j.issn.1007-9572.2022.0209
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Postpartum depression (PPD) is a common maternal mental health issue induced by a combination of biopsychosocial factors, which seriously affects the physical and mental health of mothers and infants. Screening for individual maternal risk factors during pregnancy for predicting PPD will contribute to early identification and treatment of PPD. Many prediction models have been developed and extensively used in the research on the etiology of PPD, and classifying and comparing different types of the models could provide an important reference for selecting a rational method for developing the model, and help to increase the forms of PPD screening and diagnosis.

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30. Motivational Impairment and Its Associated Factors in Schizophrenia: a Review of Recent Developments
Rui MA, Weiliang WANG, Yu WANG, Yuqiu ZHOU
Chinese General Practice    2022, 25 (21): 2670-2674.   DOI: 10.12114/j.issn.1007-9572.2022.0110
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Motivation impairment is highly valued in the treatment and functional rehabilitation of schizophrenia as it is a core symptom of the illness. Although new developments have been made in motivation impairment, but its associated factors are not entirely clear. We reviewed recent studies in motivational impairment in schizophrenia, and made a detailed summary of the features, assessment, and associated factors of motivational impairment, providing ideas for the development of strategies for clinical intervention of schizophrenia.

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31. Recent Advances in Self-determined Motivation towards Rehabilitation Treatment in Schizophrenia Patients
Kai YU, Yu WANG, Weiliang WANG, Yuqiu ZHOU
Chinese General Practice    2022, 25 (21): 2675-2679.   DOI: 10.12114/j.issn.1007-9572.2022.0103
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Schizophrenia is a severe mental disorder that endangers patients and their families' lives as well as the society. Over 80% of patients cannot be cured completely, one contributor to which is patients' lack of self-determined motivation for treatment. There are few studies on self-determined motivation for treatment among patients with schizophrenia in China. Self-determined motivation facilitates the development of positive emotions, behaviors and cognition, which also plays a vital role in the promotion health-related behaviors. We reviewed the latest advances in self-determined motivation towards rehabilitation treatment in schizophrenia patients, and gave a summary of the features and measurement methods regarding self-determined motivation, as well as its roles in predicting the effect of cognitive remediation, physical therapy and other types of rehabilitation treatment, and in maintaining treatment adherence. After that, we made suggestions on the problems to be solved. To improve treatment adherence and cure rate in schizophrenia patients, future studies may focus on developing appropriate interventions in accordance with the self-determined motivation of the patients.

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32. Efficacy of Attention Bias Modification in Individuals with Depression: a Meta-analysis
Haisha XIA, Xiaobo LIU, Xinyun GOU, Wenjing TANG, Dongling ZHONG, Yuxi LI, Zhong ZHENG, Juan LI, Rongjiang JIN
Chinese General Practice    2022, 25 (17): 2145-2151.   DOI: 10.12114/j.issn.1007-9572.2022.0182
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Background

Attention bias modification (ABM) , a newly emerging focus in emotion modification research, is a treatment to reduce individuals' attention bias toward negative stimuli to improve their abnormal cognition via repeated computer-based attention trainings toward neutral or positive stimuli. Recent studies about depression treated using ABM are increasing, but based on insufficient evidence with various efficacy assessment indicators.

Objective

To systematically assess the effect of ABM in patients with depression.

Methods

Databases including PubMed, The Cochrane Library, EMBase, CBM, CNKI, WanFang Data and VIP were searched from inception to December 31st, 2021 for randomized controlled trials (RCTs) regarding depressive patients treated by ABM (experimental group with computer-based ABM trainings) compared with placebo trainings under the same conditions (control group with no interventions or sham ABM trainings) . Primary outcome measures included Hamilton Rating Scale for Depression (HAMD/HRSD) , Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) . Secondary outcome measures included the State-Trait Anxiety Inventory (STAI-T) and Ruminative Responses Scale (RRS) . Two researchers independently performed literature enrollment, and extracted data, and evaluated the risk of bias using Risk of Bias 2 (RoB 2.0) tool. RevMan 5.4 and Stata 12.0 were used for Meta-analysis.

Results

Thirteen RCTs involving 968 patients were included, among which one had two trials. Risk of bias was low in seven RCTs, unclear in four, and high in two. Meta-analysis showed that the overall improvement of depression, anxiety and rumination in the experimental group was better than that in the control group (P<0.05) . Further analysis indicated that two groups had no significant differences in mean scores of BDI and HAMD within a follow-up period of less than two months (P>0.05) . When the follow-up time was prolonged to at least two months, the mean BDI score was still similar in both groups (P>0.05) .

Conclusion

ABM treatment could improve depressive, anxiety symptom and rumination in patients with depression, but its long-term effect needs to be studied further.

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33. Mediating Effect of Marital Satisfaction Level on the Relationship between Partner Phubbing and Depression in Late Pregnancy
Yun TIAN, Yuhong LI, Jingjing ZHAO, Yudong ZHANG, Liu ZHANG
Chinese General Practice    2022, 25 (20): 2541-2546.   DOI: 10.12114/j.issn.1007-9572.2022.0072
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Background

The prevention and treatment of depression is a priority among mental health issues in China, and pregnant women are a key target group. Prenatal depression is easily ignored although it is highly prevalent and harmful. To reduce its prevalence, it is crucial to identifying the interaction mechanism between psychosocial factors (such as marital satisfaction and partner support) associated with prenatal depression, and controlling the modifiable risk factors.

Objective

To explore the relationship between marital satisfaction, partner phubing and depression in late-pregnancy women, and to assess the level of mediating effect of marital satisfaction on the relationship between the latter two, providing maternal and child healthcare professionals with evidence on interventions for prenatal depression.

Methods

Convenience sampling method was used to select women in late pregnancy who underwent routine prenatal check-ups in the Obstetrics Clinic, the First Affiliated Hospital of Anhui Medical University from October 2020 to May 2021. A self-designed general information questionnaire was used to collect sociodemographic and obstetric data. The Partner Phubbing Scale (PPS) was used to assess partner phubbing prevalence. The Quality of Marriage Index (QMI) was used to measure the level of marital satisfaction. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the prenatal depression prevalence. Mplus 8.3 was used to establish a structural equation model for mediation analysis.

Results

Altogether, 300 cases were recruited. All of them were included for analysis except nine cases who returned unresponsive questionnaires, obtaining a survey response rate of 97.00%. The prenatal depression prevalence in the respondents was 40.89% (119/291) . The mean scores of PPS, QMI, and EPDS for them were (25.6±6.3) , (37.9±6.0) , and (8.0±3.5) , respectively. Correlation analysis showed that partner phubbing was negatively associated with marital satisfaction (r=-0.292, P<0.01) , and positively associated with prenatal depression (r=0.350, P<0.01) . Marital satisfaction level was negatively correlated with prenatal depression (r=-0.338, P<0.01) . Mediation analysis revealed that the size of direct effect of partner phubbing on prenatal depression was 0.214, accounting for 82.63% of the total effect. Marital satisfaction partially mediated the relationship between partner phubbing and prenatal depression, with a size of mediation effect of 0.045, accounting for 17.37% of the total effect.

Conclusion

Partner phubbing could positively predict depression in late pregnancy, and their relationship may be partially mediated by marital satisfaction. To reduce the prevalence of depression in late pregnancy, maternal and child healthcare professionals could improve the marriage of pregnant woman via providing them with interventions to decrease the prevalence of partner phubbing.

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34. Beijing's Mental Health Workers' Perceptions of the Severe Mental Illness Reporting System
Haomin WANG, Xiaoyong LI, Ning ZHANG, Jiaoyue WU
Chinese General Practice    2022, 25 (16): 2014-2020.   DOI: 10.12114/j.issn.1007-9572.2022.0143
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Background

The Severe Mental Illness Reporting System (SMIRS) has been operated for many years as an important part of mental health monitoring, but its effectiveness needs to be further explored.

Objective

To analyze the perceptions of mental health workersfrom municipal-, district- and community-level hospitals in Beijing regarding the importance, main role, effects and problems during the implementation, and improvement measures concerning the SMIRS, providing suggestions facilitating the improvement of the system.

Methods

From March to June 2019, a survey was conducted among a convenient sample of 234 mental health workers from municipal-level psychiatric hospitals, and two stratified samples of 397 mental health workers (one sample of 183 cases from district-level psychiatric hospitals, and the other sample of 214 cases from community-level hospitals) , using a questionnaire named Status of the Rule of Mental Health Laws in Beijing for understanding these workers' general information and their perceptions of the SMIRS.

Results

The SMIRS was assessed as "very important" by 56.3% (103/183) of the mental health workers from district-level hospitals and 54.7% (117/214) of those from community-level hospitals, and as "relatively important" by 66.7% (156/234) of those from municipal-level hospitals.The major role of the SMIRS was assessed as "risk warnings for mental illnesses" by 76.9% (180/234) of the mental health workers from municipal-level hospitals and 82.7% (177/214) of those from community-level hospitals, and as facilitating community-based management of mental illnesses by 80.9% (148/183) of those from district-level hospitals. The implementation effectiveness of the SMIRS was evaluated as "relatively good" by 44.4% (104/234) of mental health workers from municipal-level hospitals, 50.3% (92/183) of those from district-level hospitals, and 50.9% (109/214) of those from community-level hospitals. And the number of workers choosing "relatively good" accounted for the highest percentage of the total workers from each kind of hospitals. The major problem during the implementation of the SMIRS was assessed as "involving patient privacy" by 77.8% (182/234) of the mental health workers from municipal-level hospitals, 78.1% (143/183) of those from district-level hospitals, and 83.2% (178/214) of those from community-level hospitals. And the number of workers choosing "involving patient privacy" accounted for the highest percentage of the total workers from each kind of hospitals. "Standardizing the system of information entry, registration, correction, and summary" was chosen as a measure for improving the implementation of the SMIRS by 73.5% (172/234) of the mental health workers from municipal-level hospitals, and 76.6% (164/214) of those from community-level hospitals, while "standardizing the system of information sharing and protection of patients' privacy" was chosen by 68.9% (126/183) of those from district-level hospitals.

Conclusion

The role and implementation effectiveness of the SMIRS have won the approval of mental health workers from municipal-, district- and community-level hospitals. To further improve the implementation of SMIRS with a dual emphasis on risk containment and privacy protection and consideration for patient management services, we put forward the following recommendations: detailing relevant legal provisions; insisting on ensuring patients access to relevant services (including management) , improving the mental health service system, and implementing the essential and major public health service programs; increasing policy publicity to improve the recognition of the system by patients and their families.

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35. Association between Free Triiodothyronine and Depression in Patients with Coronary Heart Disease
Anbang LIU, Cheng JIANG, Han YIN, Huan MA, Qingshan GENG
Chinese General Practice    2022, 25 (14): 1707-1712.   DOI: 10.12114/j.issn.1007-9572.2022.0016
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Background

Cardiovascular disease and psychological disease are the two major public health problems threatening the health of Chinese residents. At present, there are about 11 million patients with coronary heart disease (CHD) in China. The comorbidity rate of coronary heart disease hospitalized patients with depression can reach 51%, and the combined major depression is 3.1% to 11.2%. At present, there are few studies on the association between thyroid function and depression status in CHD patients.

Objective

To explore the association between thyroid function and depression status in patients with CHD.

Methods

From October 2017 to February 2018, 561 patients diagnosed CHD from the Department of Cardiology of Guangdong Provincial People's Hospital were selected, and divided into coronary heart disease without depression group and CHD combined depression group according to whether depression was combined, which was evaluated by the patient health Questionnaire-9 (PHQ-9) . The gender, age, body mass index (BMI) , comorbid diseases (hypertension, diabetes, dyslipidemia, acute myocardial infarction) , the levels of high-sensitivity C-reactive protein (hs-CRP) , high-sensitivity troponin T (hs-cTnT) , N-terminal-B-type natriuretic peptide precursor (NT-proBNP) , serum free triiodothyronine, free thyroxine, thyroid-stimulating hormone, free triiodothyronine (FT3) , free thyroxine (FT4) and thyroid stimulating hormone (TSH) of patients wre recorded. Univariate and multivariate Logistic regression was used to analyze the effect of FT3 on the risk of depression in patients with CHD.

Results

CHD without depression group included 350 cases (62.4%) , CHD complicated with depression group included 211 cases (37.6%) , with 148 mild depression cases (26.4%) , 46 moderate depression cases (8.2%) , 17 severe depression cases (3.0%) . The level of FT3 in the CHD complicated with depression group was lower than that in the CHD without depression group (P<0.05) , but there was no significant difference in FT4 and TSH levels between the CHD complicated with depression group and the CHD without depression group (P>0.05) . PHQ-9 score was negatively correlated with FT3 level (rs=-0.114, P<0.05) and positively correlated with age (rs=0.093) and hs-CRP (rs=0.090) (P<0.05) in the CHD combined with depression group. The results of the univariate and multivariate Logistic regression to analyze the effect of FT3 on the risk of depression in patients with CHD showed that for each standard deviation of FT3, the risk of depression in patients with CHD decreased by 20%〔OR=0.8, 95%CI (0.67, 0.96) 〕. Similar results were observed in the FT3 quintile stratified analysis, in which the lowest risk of incident depression was observed in CHD patients in the FT3 quartile (4.98-5.34 pmol / L) , andunivariate analysis (unadjusted) showed a significant trend in OR values among the quintiles of FT3 (P<0.05) .

Conclusion

The level of serum FT3 in patients with CHD complicated with depression was lower than that in patients without depression, and the level of FT3 in severe depression group was more significant. FT3 may be a potential biochemical marker of depression in patients with CHD, and it is recommended that patients with CHD and depression should be evaluated for thyroid function.

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36.

Development and Application Effect of Knowledge-to-action Framework-based Health Management in Adolescents with Depressive Disorder in Remote Counties

LU Heli, LIU Yun, HUANG Zewen, GUO Ming, HUANG Xiaoqin, XU Xi, WANG Biyi, DONG Xiangli, LI Guanhua, HU Feihu
Chinese General Practice    2022, 25 (11): 1373-1377.   DOI: 10.12114/j.issn.1007-9572.2021.01.417
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Background

The prevalence of depressive disorder in adolescents is increasing. Adolescents with depressive disorder in remote counties and their families have a low awareness of the disease, and often are difficult to complete the whole treatment.

Objective

To explore the application effect of knowledge-to-action (KTA) framework-based health management in adolescents with depressive disorder in remote counties.

Methods

Ninety-four adolescents with depressive disorder coming from remote countries were recruited from the Second Affiliated Hospital of Nanchang University from June to December 2020. They were randomly divided into a routine group (receiving a 12-week routine health management) and a KTA group (receiving a 12-week KTA framework-based health management) . At the time of enrollment and 12 weeks after intervention, the status of non-suicidal self-injury was assessed by the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) , mobile phone use was evaluated by the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) , the anxiety was evaluated with the score of the Screen for Child Anxiety Related Emotional Disorders (SCARED) , and the depression was assessed by the Depression Self-Rating Scale for Childhood (DSRS) .

Results

Two groups had no significant differences in mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS before receiving intervention (P>0.05) .Two groups had no significant differences in each dimension score of SQAPMPU before receiving intervention (P>0.05) .After the 12-week intervention, the mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) , the each dimension score of SQAPMPU decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) .

Conclusion

KTA framework-based health management could effectively reduce the incidence of non-suicidal self-injury and the problematic use rate of mobile phones, relieve the anxiety and depression in adolescents with depressive disorder in remote counties, indicating that this type of health management may have good applicability as an outpatient management in this group.

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37.

Clinical Effect of Early Application of Self-prescribed Yiqihuoxue Decoction on Prevention and Treatment of Depressive Symptoms after Acute Myocardial Infarction

WANG Mengxi, LIU Qian, SHEN Le, CHEN Xiaohu
Chinese General Practice    2022, 25 (11): 1357-1362.   DOI: 10.12114/j.issn.1007-9572.2021.01.602
Abstract755)   HTML12)    PDF(pc) (1017KB)(247)    Save
Background

Post-acute myocardial infarction (AMI) patients are prone to depression and other negative emotions. Current treatment for post-AMI patients with depression is anti-myocardial infarction treatment plus anti-depression treatment, in the circumstances that the patients have depression. In view of this, the therapeutic program could not be used early in most post-AMI patients.

Objective

To assess the effect of early application of self-prescribed Yiqihuoxue Decoction on the prevention and treatment of post-AMI depression.

Methods

Participants were eligible AMI inpatients (n=44) who were selected from Jiangsu Province Hospital of Chinese Medicine from May 2020 to March 2021 and equally randomized into a control group and an experimental group, receiving three-week standard Western treatment, and three-week standard Western treatment with self-prescribed Yiqihuoxue Decoction, respectively. The interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured at the end of one-week treatment. At the end of three-week treatment, depression prevalence was estimated using HAMD-17 score, angina pectoris was graded using angina score, and TCM syndrome score and improvement rate of TCM syndrome were measured.

Results

The HAMD-17 score in the experimental group decreased significantly after treatment (P<0.05) . The IL-6 in both groups demonstrated a significant decrease after treatment (P<0.05) , and the decrease was much more obvious in the experimental group (P<0.05) . The IL-8 in the control group was lower after treatment than at baseline (P<0.05) . The post-treatment angina score in the experimental group was lower than that in control group (P<0.05) . The TCM syndrome score decreased significantly in both groups after treatment (P<0.05) . And it showed a much more obvious decrease in the experimental group (P<0.05) . The TCM syndrome improvement rate in the experimental group was higher than that in control group (P<0.05) .

Conclusion

For AMI patients, early use of self-prescribed Yiqihuoxue Decoction significantly reduced the serum IL-6 level, relieved angina pectoris symptoms and improved TCM syndrome, as well as slightly alleviated the incidence of depressive symptoms.

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38.

Association between Depression Prevalence and Adverse Childhood Experiences in Middle-aged and Older People

LU Weiwei, ZHU Rui, CHEN Jun, FU Tengfei, ZHANG Jian, LIN Yuejun
Chinese General Practice    2022, 25 (10): 1191-1196.   DOI: 10.12114/j.issn.1007-9572.2022.0144
Abstract881)   HTML19)    PDF(pc) (1101KB)(233)    Save
Background

Depression prevalence and adverse childhood experiences (ACEs) in middle-aged and older people has become an increasingly concerned issue, yet it in Chinese population has been less reported, and needs to be further explored.

Objective

To investigate the epidemiology of ACEs among middle-aged and elderly Chinese people, and to analyze its association with depression prevalence, providing an accurate delineation of ACEs and depression prevalence in this group of Chinese people.

Methods

Information of 7 035 middle-aged and elderly people≥ 45 years old who met the research requirements were selected during July to August, 2021 from the database of China Health and Retirement Longitudinal Study held by Institute of Social Science Survey, Peking University, in which the questions in the Center for Epidemiologic Studies Depression Scale used in the CHARLS, ACEs (including abuse, neglect, dysfunctional family) and individual characteristics were screened and generated into new dummy variables with the weight reassigned. Covariates of those with ACEs (treatment group) and those without (control group) were included in a propensity score matching model, and propensity scores of them were estimated using robust standard errors in multivariate Logistic regression, then the covariates of two groups were matched using the 1∶1 nearest neighbor matching, and were checked using balance diagnostics and common support assumption. The influence of ACEs on the depression in those with ACEs was quantified by the average treatment effect on the treated.

Results

Of the 7 035 respondents, 6 529 (92.81%) had experienced ACEs, 1 802 (25.61%) had experienced at least four ACEs, and 1 003 (14.26%) had a depressive state. Multivariate Logistic regression model demonstrated that age, gender, and self-rated health status were significantly associated with ACEs (P<0.05) . Individual characteristics of both groups after propensity score matching were comparable (P>0.05) , and went through the check of balance diagnostics and common support assumption. Propensity score matching-based analysis revealed that the risk of depression prevalence in those with ACEs was increased by a factor of 6.9% compared with those without (P<0.001) .

Conclusion

The prevalence of ACEs among middle-aged and elderly Chinese people was higher, which may significantly increase the risk of depression prevalence. Therefore, it is urgently needed to establish a system of ACEs screening and intervening to improve the level of healthcare services and well-being for these people.

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39.

Study on the Moderating Effect of Body Mass Index in Correlation of Anxiety and Depression Disorders

TIAN Yangli, YANG Zhaoxi, ZHANG Jianzhao, ZOU Xiaowei, FENG Jigao, ZHU Bo, WAN Ailan
Chinese General Practice    2022, 25 (11): 1368-1372.   DOI: 10.12114/j.issn.1007-9572.2021.01.416
Abstract870)   HTML12)    PDF(pc) (989KB)(246)    Save
Background

As two different kinds of mental disorders, anxiety disorder and depressive disorder could probably coexist in one with the proceeding of the illness. However, there are few studies on how to prevent and treat the coexistence of anxiety and depressive disorders.

Objective

To discuss the relationship between anxiety and depressive disorders, and the moderating effect of body mass index (BMI) in their relationship.

Methods

By use of simple random sampling, 86 outpatients and inpatients with anxiety disorders were selected from the First Affiliated Hospital of Nanchang University during June 1st to August, 31st, 2021. A self-made demographic questionnaire was used to obtain the demographic information. The Hamilton Anxiety Rating Scale was used to assess the anxiety level. The Hamilton Rating Scale for Depression was used to assess the depression level. Pearson correlation analyses were performed to assess the relationship between anxiety and depression disorders, and that between BMI and anxiety or depression disorder. Hierarchical regression analysis was adopted to explore the moderating effect of BMI on the relationship between anxiety and depressive disorders.

Results

Eighty eligible cases were also diagnosed with depression. The anxiety prevalence was significantly increased with depression prevalence (r=0.70, P<0.01) . BMI had no significant linear correlation with anxiety prevalence (r=0.03, P>0.05) . BMI also had no significant linear correlation with depression prevalence (r=0.14, P>0.05) . BMI moderated the relationship between anxiety and depression disorders significantly (β=-0.16, P<0.01) .

Conclusion

BMI can weaken the effect of anxiety disorder on depression, helping prevent them from developing into comorbid mental disorders, providing new ideas for developing new dietary standard or exercise patterns for mental health prevention and treatment in the future and expands the research field of nutritional psychiatry to a certain extent.

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40. Impact of Rational Emotive Behavior Therapy on Sleep and Mood in Patients with Post-stroke Depression
Ning ZHU, Yanyan DUAN, Na WANG, Mengzhou XUE
Chinese General Practice    2022, 25 (12): 1481-1486.   DOI: 10.12114/j.issn.1007-9572.2021.02.056
Abstract726)   HTML13)    PDF(pc) (1565KB)(364)    Save
Background

Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke. Antidepressant drug therapy alone could not achieve satisfactory treatment responses.

Objective

To investigate the effects of rational emotive behavior therapy (REBT) on sleep and mood in patients with post-stroke depression.

Methods

Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020, and according to random number table, they were divided into the control group (n=35) or combined treatment group (n=36) . The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets (25 mg per day within the first week, and 50 mg per day within other three weeks) . The combined treatment group received four consecutive weeks of treatment with REBT (three times per week, the treatment duration for each time lasting for 30 minutes) plus the same treatment for the control group. Pittsburgh Sleep Quality Index (PSQI) , Insomnia Severity Index (ISI) , 17-item Hamilton Depression Rating Scale (HAMD-17) , Hamilton Anxiety Rating Scale (HAMA) , and Modified Barthel Index (MBI) were used to assess pre- and post-treatment sleep quality, insomnia severity, depression prevalence, anxiety prevalence and ability to engage in basic activities of daily living, respectively.

Results

The mean scores of PSQI, ISI, HAMD-17, and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment (P<0.05) . The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups (P>0.05) . The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group (P<0.05) . The improvement in depression was much better in the combined treatment group (P<0.05) . The improvement in anxiety was more obviously in the combined treatment group (P<0.05) .

Conclusion

REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia, mood, and ability to engage in basic activities of daily living in patients with post-stroke depression.

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